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Atrial myxomas are typically found in the left atrium and are the most common among overall rare cardiac tumors. Herein, we describe the clinical course of a 72-year-old female with non-small cell lung adenocarcinoma found to have an atrial mass during an imaging for evaluation for lung cancer progression. Differentiating between distinct types of masses can pose a challenge to the treatment team especially in the setting of exiting malignancy. This case demonstrates the complex decision making involved in the diagnosis, and timing of intervention to remove atrial mass in patients with frailty and a fast-growing cardiac mass.

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Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I-IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH - cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed.

Normally, the stomach and the heart are not in direct contact because they are in different cavities, the thorax and the abdomen, respectively. When part of the stomach moves toward the chest through the diaphragm, we say there is a hiatal hernia (HH). Most of the time the HH symptoms are mild and clearly digestive. In severe cases, surgical repair of the HH is required. Even in these circumstances, digestive symptoms continue to be the most frequent. However, some patients present cardiovascular symptoms and few or no digestive symptoms. This easily creates diagnostic confusion, which leads to incorrect treatments and unnecessary expenses. In extreme cases, as seen in giant HH, the degree of cardiovascular involvement is very serious. There are documented cases that have suffered cardiac arrest, arrhythmias of different types and symptoms like classic acute myocardial infarction. It is required that clinical doctors and surgeons are aware that this complication exists. Only with this in mind can a timely diagnosis be achieved. Some emergency measures have been saving, gastric decompression with a tube being the most important. The main mechanism that explains the serious cardiovascular consequences of giant HH is cardiac compression. The dissemination of this knowledge can help save lives.

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Left atrial masses are rare but clinically significant findings, which can present as diverse pathological entities, including primary tumors, thrombi, and metastases. Their diverse pathological entities contribute to a wide range of clinical manifestations, often presenting with nonspecific symptoms that pose challenges for early diagnosis. Within the realm of medicine, unique presentations emphasize the intricate interplay between the size, location, and functional impact of pathological processes. They serve as reminders to healthcare providers to approach each patient as an individual, recognizing that even seemingly minor abnormalities can have significant consequences. To illustrate this, we present two distinct cases of patients with left atrial masses, showcasing the importance of clinical suspicion and a wide knowledge base in identifying and managing these conditions effectively.

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Transthoracic and transesophageal echocardiography detected a left atrial mass attached to the intra-atrialseptum. Intravenous contrast agent ruled out atrial thrombus, sugesting a left atrial myxoma. This highlights theimportance of contrast echocardiography for differential diagnosis of left atrial findings.

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Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.

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We report a rare case of a large left atrial myxoma that manifested as syncope in a patient who presented to the hospital following a syncopal episode. Our patient had a history of hypertension and anemia with reported two months of dyspnea on exertion. He was found to have a large left atrial myxoma. Atrial myxomas are the most common benign primary cardiac tumors. Patients may be asymptomatic or experience shortness of breath, palpitations, syncope, or sudden death. Cases of syncope caused by left atrial myxoma have been rarely documented. Our case report adds to the growing literature documenting this phenomenon. Larger observational studies are needed to properly define the incidence of left atrial myxoma causing syncope.

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Hepatoblastoma is the most common malignant liver tumor in early childhood. The metastatic extension of hepatoblastoma into the left atrium via the pulmonary vein and left ventricle is rare. Reported cases almost always involve right-sided approaches and occur in pediatric patients. However, we are reporting a case of a 22-year-old female with recurrent hepatoblastoma at multiple sites, including the left atrium, left ventricle, brain, and lung.

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While metastasis is common, it is unusual for renal cell carcinoma (RCC) to spread to the heart and even more so without involving the inferior vena cava (IVC). In fact, only a few cases have been reported where RCC has metastasized to the heart without IVC invasion. There have been only a few cases published that show RCC metastasis to the heart without invasion through the IVC. Here, we present an interesting case of a patient that was found to have RCC metastasis to the lungs that had a direct invasion to the left atrium.

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Chest pain and dyspnoea are among the most common complaints seen in the emergency room and each symptom calls for a broad differential diagnosis. Large hiatal hernias are infrequent, but they can lead to atypical symptoms mimicking different cardiovascular, pulmonary and neoplastic diseases. We present two cases of older patients with an apparent left atrial mass on transthoracic echocardiography, which was subsequently identified as hiatal hernia by other imaging modalities. A multidisciplinary team with multimodality imaging is necessary for diagnostic work-up of chest pain and dyspnoea of non-cardiac origin and especially for a suspected mass compressing the heart, causing chest discomfort. LEARNING POINTS: Hiatal hernia (HH) can mimic different cardiovascular, pulmonary and neoplastic diseases.HH has a typical echocardiographic (2DE) presentation as an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion.Oral ingestion of a carbonated drink may help to distinguish between a large HH and an atrial mass by 2DE.

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Cardiac myxoma recurrence is uncommon following surgical resection. Recurrence is about 2-3% in familial cases; however, recurrence is uncommon in sporadic cases. Most of the recurrences will occur during the first three to four years. Ten percent of myxomas are of the inherited autosomal dominant disorder called Carney's complex, while the rest appear sporadic. We are reporting a nonfamilial case of atrial myxoma, recurring rapidly seven years after resection of the initial left atrial myxoma with a pathologically proven clear margin and no malignant transformation. Cardiac neoplasms are rare and occur less commonly than metastatic disease of the heart. Congestive heart failure symptoms and thromboembolism account for nearly half of the presenting signs and symptoms. The initial presentation of our case was an embolic phenomenon, presenting with a stroke. The patient subsequently underwent resection of the mass, with pathology confirming the complete excision of the myxoma with a clear margin and no evidence of malignant transformation. Our patient was closely followed up in the clinic on annual transthoracic echocardiography surveillance, with a recurrence noted on surveillance echocardiography in 2021 (seven years after initial diagnosis) despite the patient being asymptomatic. This case illustrates transthoracic echocardiography as the mainstay of detection of recurrent left atrial myxoma; however, it also asks the question of how often patients need to be screened for recurrence of left atrial myxoma and for how long they need to have surveillance echocardiography. Clinical presentation and transesophageal echocardiographic views are extremely helpful in sharpening the accuracy of the diagnosis.

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Primary cardiac tumors are extremely rare and mostly metastatic in origin. The signs and symptoms depend on the location of the tumor rather than its histopathology and, rarely, may be the first presentation of the malignant disease. We report a 54-year-old woman diagnosed with non-small lung cancer with new-onset heart murmur and dyspnea on exertion as the first clinical manifestations.

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A 75-year-old Caucasian female with a past medical history including insulin-dependent diabetes mellitus, hypertension, and dyslipidemia, presented to the emergency room for having palpitations for three weeks. Echocardiography revealed a very large left atrial mass mimicking myxoma. Mass was excised and examined by pathology, revealing a mural thrombus. A mural thrombus is not an uncommon mass found in the left atrium. However, it does not often present symptomatically, strongly mimics an atrial myxoma on cardiac imaging, and has rarely ever been reported to be greater than seven centimeters in any dimension. We present a case of a 75-year-old Caucasian woman with a massive, symptomatic cardiac thrombus masquerading as a myxoma on imaging.

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Primary cardiac synovial sarcoma is a very rare primary cardiac tumor that usually arises in the right side of the heart. Brain metastases in primary cardiac sarcomas are not uncommon. Because of the wild nature of these tumors, they usually have poor outcomes. This study describes a 29-year-old female who presented with blurred vision, headache, nausea, vomiting and brain lesions in the radiologic study. Incidentally, two-dimensional echocardiography revealed a left atrial lesion. The patient underwent emergency cardiac surgery to resect the left atrial mass that arose from the atrial free wall and pulmonary veins. The diagnosis of the lesion was primary synovial sarcoma in the histopathologic examination.

Tumors that usually arises in the right side of the heart are very rare. These tumors can spread to other parts like brain. Because of the wild nature of these tumors, they usually have poor results. This study describes a 29-year-old female who comes to the hospital with vision problems, headache, nausea, vomiting and brain masses in the imaging. In addition, there was a mass on the left side of her heart. The patient underwent emergency heart surgery to resect the mass that arose from the heart wall and lung veins. The nature of the lesion was primary synovial sarcoma in the pathologic examination.

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We report a case of a left atrial mass in a 62-year-old patient with no relevant past history. He presented with dyspnea of 1 year duration. Clinical examination revealed a blood pressure of 130/82mmHg, a heart rate of 80 beats per minute. The heart sounds S1 and S2 were normal with no added sounds. Electrocardiogram showed a normal sinus rhythm at 78 beats per minute with premature ventricular contractions. Two dimensional echocardiography revealed a large mobile mass attached to the interatrial septum occupying the most of the left atrium and prolapsing into the left ventricle during diastole. There was dilatation of the right atrium and right ventricle with elevated pulmonary artery systolic pressure (85mmHg). The mean transmitral pressure gradient was 5.5mmHg. The mass was compatible with a myxoma. The patient was sent for surgical resection of the mass but this could not be performed due to financial constraints.

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This case report is about an 81-year-old male patient that was brought into the emergency room. Paramedics and an emergency doctor were alarmed because of unconsciousness of unclear origin. Additionally, ST-elevation were detected preclinically, raising the suspicion of an intercerebral hemorrhage; however, the clinical work-up revealed a different and unsuspected cause.

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Background: Left atrial dissection is an uncommon entity associated with cardiac surgery, catheter interventional procedures, or cardiac trauma. Spontaneous cases have also been reported. The entry of left atrial dissection often occurs in the posterior annulus of the mitral valve, which is also a favourable site for mitral annular calcification (MAC). We herein report a rare case of spontaneous left atrial dissection caused by a disruption of MAC. Case summary: An 84-year-old woman was admitted to our hospital for chest discomfort. Transthoracic echocardiography showed severe calcification of the posterior mitral annulus and a heterogeneous mass in the posterior wall of the left atrium adjacent to MAC. Transoesophageal echocardiography showed blood flow through MAC from the left ventricle into the mass. Cardiac computed tomography showed the disruption of MAC, which was the entry for left atrial dissection and haematoma. The conservative approach was continued, as the haemodynamic state was stable and because of her frailty and many complications. No further events occurred during 6 months follow-up, although the false cavity did not regress. Discussion: The diagnosis of an intracardiac mass can be challenging. In our case, a detailed anatomical evaluation with multiple imaging modalities allowed us to understand the disease and manage it appropriately.

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Cardiac tumors (CTs) are a rare group of disorders that encompass a broad set of masses. They are subclassified into neoplastic and non-neoplastic lesions. Neoplastic lesions can be further subdivided into either primary cardiac tumors (PCTs) or secondary cardiac tumors (SCTs) which are metastasis to the heart. Cardiac myxomas are the most common pathological type of benign PCT followed by rhabdomyomas, papillary fibroelastomas, fibromas, lipomas, and leiomyomas. Here, we present a case of a patient with left atrial mass in the setting of stage IV prostate cancer. We have used transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for characterization and differential generation. Our findings are presented in high-quality imaging and video and our top differentials include PCT, thrombi, and metastasis. Although a full diagnostic workup was not completed due to limitations in diagnostic tests available, metastasis to the heart could not be excluded due to the high staging and extensive sclerotic involvement of this malignancy. We emphasized the importance of multimodality imaging, e.g., TTE, TEE, cardiac magnetic resonance (CMR), and cardiac computed tomography (CT) in the workup of incidental cardiac masses and differential refinement.

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Primary cardiac tumors are rare, and myxoma is a rare benign primary cardiac tumor in adults, commonly found within the left atrium. The presentation can vary from patients being asymptomatic to pulmonary embolism or stroke. Smaller atrial myxomas are usually asymptomatic, however, larger ones can cause symptoms such as dyspnea, orthopnea, cough, peripheral edema, palpitations, and fatigue. We present a case report of a 72-year-old patient presenting with right shoulder pain and chest pain on breathing to the accident and emergency department. The patient was complaining of right shoulder pain for five days and pleuritic chest pain for the last 48 hours. Initial electrocardiogram showed normal sinus rhythm, however, repeat electrocardiograms showed atrial fibrillation. An echocardiogram showed a homogeneous, relatively round mass seen in the left atrium, close to the inter-atrial septum, and close to the roof of the left atrium, and the patient underwent surgical removal of the benign tumor.

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We treated an 80-year-old Japanese woman who had Takotsubo syndrome (TTS) concomitant with a left atrial (LA) tumor. Left ventriculography revealed a variant of TTS. In cardiac surgery, the LA mass was successfully resected without embolism, with the pathological diagnosis of myxoma.